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<title>Form 7</title>
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<td width="650"><form id="form1" name="form1" method="post" action="">
  <h1>Retreat Registation
  </h1>
  Nov 24 - 25 (Sat, Sun, Mon)
  <hr width="430" align="left" />
  <table width="325" height="127" border="0" cellpadding="0" cellspacing="0">
    <tr>
      <th colspan="2" align="left" valign="bottom"><label><b>Name</b></label></th>
    </tr>
    <tr>
      <td><input name="textfield" type="text" id="textfield" size="20" /></td>
      <td><input name="textfield2" type="text" id="textfield2" size="20" /></td>
    </tr>
    <tr>
      <td valign="top">Frist</td>
      <td valign="top">Last</td>
    </tr>
  </table>
  <table width="503" height="169" border="0" cellpadding="0" cellspacing="1">
    <tr>
      <th colspan="6" align="left" valign="bottom"><label><b>Address<span style="color:#F00">*</span></b></label></th>
    </tr>
    <tr>
      <td colspan="6"><input name="textfield3" type="text" id="textfield3" size="71" /></td>
    </tr>
    <tr>
      <td colspan="6" valign="top">Street Address</td>
    </tr>
    <tr>
      <td colspan="6" valign="top"><input name="textfield4" type="text" id="textfield4" size="71" /></td>
    </tr>
    <tr>
      <td colspan="6" valign="top">Address line 2</td>
    </tr>
    <tr>
      <td colspan="3" valign="top"><input name="textfield5" type="text" id="textfield5" size="33" /></td>
      <td colspan="3" valign="top"><input name="textfield6" type="text" id="textfield6" size="33" /></td>
    </tr>
    <tr>
      <td colspan="3" valign="top">City</td>
      <td colspan="3" valign="top">State/Province/Region</td>
    </tr>
    <tr>
      <td colspan="3" valign="top"><input name="textfield7" type="text" id="textfield7" size="33" /></td>
      <td colspan="3" valign="top"><select name="select" size="1" id="select" style="width:215px">
      </select></td>
    </tr>
    <tr>
      <td colspan="3" valign="top">Postal/Zipcode</td>
      <td colspan="3" valign="top">Country</td>
    </tr>
    <tr>
      <th colspan="3" align="left" valign="top"><br />Phone</th>
      <th colspan="3" align="left" valign="top" bgcolor="#FFFFFF"><br />Email<span style="color:#F00">*</span></th>
    </tr>
    <tr>
      <td width="55" align="left" valign="top"><input name="textfield8" type="text" id="textfield8" size="1" />
        -<br />
        ###</td>
      <td width="55" align="left" valign="top"><input name="textfield9" type="text" id="textfield9" size="1" />
        -<br />
###</td>
      <td width="119" align="left" valign="top"><input name="textfield10" type="text" id="textfield10" size="1" />
        <br />
###</td>
      <td colspan="3" valign="top"><input name="textfield11" type="text" id="textfield11" size="33" /></td>
    </tr>
    <tr>
      <th colspan="3" align="left" valign="top"><br />Arrival Date</th>
      <th colspan="3" align="left" valign="top"><br />Departer Date</th>
    </tr>
    <tr align="left" style="font-size:12px">
      <td valign="top"><input name="textfield12" type="text" id="textfield12" size="1" />
        /<br />
        MM</td>
      <td valign="top"><input name="textfield13" type="text" id="textfield13" size="1" />
/<br />
DD</td>
      <td valign="top"><input name="textfield14" type="text" id="textfield14" size="1" />
        <br /> 
YYYY
</td>
      <td width="37" valign="top"><input name="textfield15" type="text" id="textfield15" size="1" />
/<br />
MM</td>
      <td width="39" valign="top"><input name="textfield16" type="text" id="textfield16" size="1" />
/
<br />
DD</td>
      <td width="239" valign="top"><input name="textfield17" type="text" id="textfield17" size="1" />
        <br /> 
YYYY
</td>
    </tr>
    <tr align="left">
      <th colspan="6" valign="top"><br />Accomodation Status<br />
        <select name="select2" id="select2" style="width:160px">
      </select></th>
    </tr>
    <tr align="left">
      <th colspan="6" valign="top"><br />Special Needs<br />
      <textarea name="textarea" id="textarea" cols="45" rows="5" style="width:437px; height:79px"></textarea></th>
    </tr>
    <tr align="left">
      <th colspan="6" valign="top"><br /><input type="submit" name="button" id="button" value="Submit" /></th>
    </tr>
  </table>
  <h4><br />
  </h4>
  <p>&nbsp;</p>
  <p>&nbsp;</p>
  <p>&nbsp;</p>
</form></td>
<td width="300"></td>
</table>
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